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In Los Angeles, hospitals dumping homeless patients on Skid Row has become a scandal. Prosecutors are investigating more than 50 cases and a state senator wants to criminalize patient dumping. Hospitals say they can barely keep up with treating homeless patients. The costs are huge and doctors and nurses say emergency rooms are swamped.
NPR's Elaine Korry reports on the complicated relationship between the homeless and the hospitals in Los Angeles.
Unidentified Man: The other side, come on.
(Soundbite of car horn)
ELAINE KORRY: I'm standing at the corner of Fifth Street in Skid Row. It's a dilapidated area tucked between the garment and warehouse district where lots of homeless people congregate. And the population here is well aware of these reports of hospital-dumping. Oscar Johnson(ph) is a man in his mid-50s and he says he sees it all the time.
Mr. OSCAR JOHNSON (Resident, Skid Row): Yeah, I've seen it in several occasions that, you know, there's people that's coming from the hospital with their night clothes on, you know, from the hospital, clothes still on. And they've been dropped off down on Skid Row and keep on going.
KORRY: And then what happens to those people after they're dropped off?
Mr. JOHNSON: They just hang out down here with the homeless, that's all.
KORRY: Johnson says no one cares what happens to these patients, but in fact they've got a local champion. State Senator Gilbert Cedillo wants to punish hospitals when homeless patients wind up in the street. But advocates say his legislation masks a much bigger problem. There are 90,000 homeless people in L.A. County and maybe 10,000 shelter beds. So on any given night, guess where a lot of homeless people end up.
(Soundbite of beeping)
Doctor ED NEWTON (Los Angeles County USC Medical Center): We're at the L.A. County USC Medical Center in the emergency department.
KORRY: It's a Sunday evening and Doctor Ed Newton is the attending physician here.
Dr. NEWTON: This is one of the busiest trauma centers in the country. If not the busiest...
KORRY: We're in a big, brightly lit room with resuscitation crash carts in the center, and about 20 curtained booths lining the green wall. Patients on gurneys spill into the hallway waiting their turn to be seen for everything from cardiac arrest, and seizures, to gunshot wounds, and stabbings.
(Soundbite of intercom)
KORRY: Newton says the department treats about 400 patients each day and perhaps one in five of them is homeless. This hospital is not accused of dumping. He says all patients receive high-quality care, but he's not surprised to hear some complaints.
Dr. NEWTON: Long, long wait times. And that's just the function of the fact that there are so many uninsured people in Los Angeles. The sickest people get in faster and the less sick people end up having to wait a long time and, you know, there's just really isn't enough resources here to deal with the demand that we have.
KORRY: Uninsured patients cost L.A. hospitals about $2 billion a year, but by law, they must treat anyone who's sick - whether or not they can pay.
(Soundbite of crying)
KORRY: Nursing Supervisor Henri Ativecendo(ph) walks me around to one of the overflowing waiting rooms. She does a quick head count of the less critical patients. Some of them had been here since last night.
Ms. HENRI ATIVECENDO (Nursing Supervisor, Los Angeles County USC Medical Center): Around a hundred patients. Usually Monday to Sunday, it's always packed. It's always packed.
KORRY: There are families with babies, old women with walkers, and lots of middle-aged men in torn clothing and dirty blankets.
Unidentified Woman: As the evening progresses, the homeless come here, and it becomes like a place to stay. You know, it's safe, and sometimes they get some free food, you know.
KORRY: It's 7:00 p.m. and there are noticeably more homeless patients now. Often they arrive with minor injuries, and they time their visit so they can stay in the waiting room overnight. In the back row sits a man in a tattered denim jacket.
Mr. DANNY AUTOLUTANO(ph): Somebody tried to steal my bike, and they hit me with a metal pipe.
KORRY: Forty-one-year-old Danny Autolutano lives under a freeway bridge near Skid Row.
I see your hand looks very swollen. How does it feel?
Mr. AUTOLUTANO: Sore. It hurts.
KORRY: And when did that happen?
Mr. AUTOLUTANO: The night before last.
KORRY: Autolutano says he called 911, and the paramedics arrived, but they wouldn't transport him because he wasn't hurt badly enough. It took him another day to come up with the money for a bus token. Forty-year-old Martin Brand(ph) is dozing in a plastic chair with a wool cap pulled over his eyes. He's here because he has sharp pains in his belly.
Mr. MARTIN BRAND: I've been throwing up since this morning. Basically that's why.
KORRY: Have you ever been here before?
Mr. BRAND: Yes, I have, many times.
KORRY: In fact, he was here just last month, vomiting blood. And that's another problem: homeless people who use emergency rooms like a local clinic. A study from the University of San Diego followed 15 chronically homeless alcoholics. Over the course of 18 months, they logged more than 400 ER visits and ran up a total bill of $1.5 million.
Now it's 10:00 p.m. Every seat in the waiting room is taken and ER nurse manager Kathy Garvin(ph) needs to check on a new arrival. She says homeless patients show up with all kinds of illnesses.
Ms. KATHY GARVIN (Emergency Room Nurse Manager): It's the same diseases, just more progressed than the general population. A lot of diabetes, a lot of seizure. We see drug and alcoholism, a lot of mental health issues are huge, and a lot of times it's a combination of all of those.
KORRY: Of course, says Garvin, homeless patients deserve to be treated with the same care and compassion as anyone else. She doesn't condone dumping. In fact, she says, social workers here move mountains to make sure that patients are not discharged to the streets. If anything, says Garvin, the problem is just the opposite.
Ms. GARVIN: There's also times when patients never want to leave. They want to move in. We have patients that come every single day.
KORRY: Meanwhile, the price tag adds up. One day in the hospital costs the county as much as 45 days of supportive housing, and Garvin's angry that no one seems to care.
Ms. GARVIN: Hospitals, which are under-funded, under-staffed and drowning in patients right now, are being asked to be the entire social network. We can't be the only one.
KORRY: She wants to know where's the affordable housing, the drug rehabs, the mental-health clinics that Skid Row patients need? They're full or closed or out of funding, and so the homeless continue to come to the one place that's guaranteed to be open and can't turn them away.
Lawmakers held a hearing today on Senator Sedillo's(ph) bill to criminalize patient dumping, but the doctors and nurses here in the ER say instead of blaming them, lawmakers need to face the root causes of homelessness and start coming up with solutions. Elaine Korry, NPR News.
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